数字减影血管造影足部血管交叉征象在判断跖背动脉分型中的初步应用

Preliminary application of foot vascular cross sign in digital subtraction angiography in judging the classification of metatarsal dorsal artery

目的探究数字减影血管造影(DSA)中一种足部血管交叉征象在判断第一跖背动脉分型中的可行性。方法选取2021年10月~2023年3月在首都医科大学附属北京积水潭医院手外科治疗的11例住院患者,均单侧拇指缺如,并在趾甲皮瓣术式修复拇指的术前进行了供区足部数字减影血管造影检查,根据造影结果对第一跖背动脉的Gilbert分型进行判断,并在术中进行验证。结果入组的11例患者中,根据DSA结果的后前位和侧位判断第一跖背动脉分型,其中GilbertⅠ型3例(27.3%),Ⅱa型4例(36.4%),Ⅱb型1例(9.1%),Ⅲ型共3例(27.3%)。GilbertⅠ型和Ⅱ型的足背和第一跖背动脉与足底动脉和足底外侧动脉均在DSA时显影构成血管交叉征象。术中显露跖背动脉后所见血管情况与术前通过数字减影血管造影判断的Gilbert分型完全吻合,准确率为100%。本组患者术后趾甲皮瓣全部成活。结论第一跖背动脉在血管造影显示的血管交叉征象是明确判断其Gilbert分型的重要征象,对于切取长血管蒂趾甲皮瓣术前规划具有重要意义。

Objective To explore the feasibility of a foot vascular sign called"cross sign"in digital subtraction angiography(DSA)in judging the classification of the first dorsal metatarsal artery.Methods 11 patients who underwent hand surgery in Department of Hand Surgery in Beijing Jishuitan Hospitalfrom October 2021 to March 2023 were enrolled.All patients had unilateral thumb loss and underwent digital subtraction angiography of the donor site's foot before the thumb was repaired with the great toe-nail flap surgery.Based on the imaging results,the Gilbert's classification of the first dorsal metatarsal artery was judgd and validated during surgery.Results Among the 11 enrolled patients,the classification of the first dorsal metatarsal artery was determined based on the posterior anterior and lateral DSA results.Among them,there were 3 cases of Gilbert type Ⅰ(27.3%),4 cases of type Ⅱa(36.4%),1 case of type Ⅱb(9.1%),and 3 cases of Gilbert type Ⅲ(27.3%).Type Ⅰ and type Ⅱ dorsalis pedis arteries and FDMA,together with the plantar artery and lateral plantar artery,appear as a"cross sign"on DSA.The vascular condition observed after exposing the dorsal metatarsal artery during surgery is completely consistent with the Gilbert's classification judged by preoperative DSA,with an accuracy rate of 100%.All the patients in this group survived with the toe-nail flap after surgery.Conclusions The"cross sign"of the FDMA in angiography is an important sign for clearly judging its Gilbert’s classification,which is of great significance for preoperative planning of harvesting long vessel pedicled toe-nail flap.